Pancreatic cancer early detection:Expanding higher-risk group with clinical and metabolomics parameters

Pancreatic ductal adenocarcinoma(PDAC)is the fourth and fifth leading cause of cancer death for each gender in developed countries.With lack of effective treatment and screening scheme available for the general population,the mortality rate is expected to increase over the next several decades in contrast to the other major malignancies such as lung,breast,prostate and colorectal cancers.Endoscopic ultrasound,with itshighest level of detection capacity of smaller pancreatic lesions,is the commonly employed and preferred clinical imaging-based PDAC detection method.Various molecular biomarkers have been investigated for characterization of the disease,but none are shown to be useful or validated for clinical utilization for early detection.As seen from studies of a small subset of familial or genetically high-risk PDAC groups,the higher yield and utility of imaging-based screening methods are demonstrated for these groups.Multiple recent studies on the unique cancer metabolism including PDAC,demonstrate the potential for utility of the metabolites as the discriminant markers for this disease.In order to generate an early PDAC detection screening strategy available for a wider population,we propose to expand the population of higher risk PDAC group with combination clinical and metabolomics parameters.

Eosinophilic cholangitis: A case report of diagnostically challenging eosinophilic infiltrative biliary obstruction

BACKGROUND Evaluation of biliary strictures primarily focuses on ruling out malignancy in older age groups.With endoscopic tools such as endoscopic ultrasound(EUS)and cholangioscopy,improved biliary visualization has enhanced the investigation of intraluminal biliary lesions and provided modalities for targeted biopsies.Benign biliary strictures,however,may pose a diagnostic dilemma.CASE SUMMARY A 71-year-old female with past medial history of hypothyroidism presenting for abnormal biliary imaging.Patient’s previous evaluation was concerning for common bile duct dilation with cholelithiasis,for which she underwent a cholecystectomy.Due to persistent symptoms and worsening liver function tests,she presented to our institution for further workup.Subsequently,the patient underwent an EUS and multiple ERCP’s with cholangioscopy;biliary biopsies revealed no evidence of malignancy but concerning for prominent eosinophilic infiltration.After further review of multiple pathology specimens and the benign clinical course,we diagnosed the patient with eosinophilic cholangitis.CONCLUSION Eosinophilic cholangitis is a rare disease and can present as a challenging case diagnostically.This case raises the potential utility of quantitative eosinophilic infiltration reporting in creating an objective diagnostic metric for eosinophilic cholangitis.

Role of endoscopic ultrasound for pre-intervention evaluation in early esophageal cancer

BACKGROUND Endoscopic ultrasound(EUS)stands as an accurate imaging modality for esophageal cancer staging,however utilization of EUS in early-stage cancer management remains controversial.Identification of non-applicability of endoscopic interventions with deep muscular invasion with EUS in pre-intervention evaluation of early-stage esophageal cancer is compared to endoscopic and histologic indicators.AIM To display the role of EUS in pre-intervention early esophageal cancer staging and how the index endoscopic features of invasive esophageal malignancy compare for prediction of depth of invasion and cancer management.METHODS This was a retrospective study of patients who underwent pre-resection EUS after a diagnosis of esophageal cancer at a tertiary medical center from 2012 to 2022.Patient clinical data,initial esophagogastroduodenoscopy/biopsy,EUS,and final resection pathology reports were abstracted,and statistical analysis was conducted to assess the role of EUS in management decisions.RESULTS Forty nine patients were identified for this study.EUS T stage was concordant with histological T stage in 75.5%of patients.In determining submucosal involvement(T1a vs T1b),EUS had a specificity of 85.0%,sensitivity of 53.9%,and accuracy of 72.7%.Endoscopic features of tumor size>2 cm and the presence of esophageal ulceration were significantly associated with deep invasion of cancer on histology.EUS affected management from endoscopic mucosal resection/submucosal dissection to esophagectomy in 23.5%of patients without esophageal ulceration and 6.9%of patients with tumor size<2 cm.In patients without both endoscopic findings,EUS identified deeper cancer and changed management in 4.8%(1/20)of cases.CONCLUSION EUS was reasonably specific in ruling out submucosal invasion but had relatively poor sensitivity.Data validated endoscopic indicators suggested superficial cancers in the group with a tumor size<2 cm and the lack of esophageal ulceration.In patients with these findings,EUS rarely identified a deep cancer that warranted a change in management.